The Obesity Medicine Association: Increasing Collaboration and Awareness of Obesity Medicine as a Cost-effective Treatment for Obesity

An Interview with:

Wendy Scinta MD, MS
President of the Obesity Medicine Association; Medical Director of Medical Weight Loss of New York, Fayetteville, New York; Founder of the BOUNCE Pediatric Obesity Program; Assistant Professor of Family Medicine, SUNY Upstate, Syracuse, New York; and Founder/Medical Director of One Stone Technology.

FUNDING: No funding was provided for this article.

DISCLOSURES: The author is the president of the Obesity Medicine Association.

Bariatric Times. 2018;15(9):10–13.

What initiatives are at the forefront in the field of obesity medicine today?

Dr. Scinta: The Obesity Medicine Association (OMA) has been heavily involved in a variety of advocacy efforts to achieve obesity parity. Some of our efforts are intra-organizational (including an upcoming meeting with members of the Donald Trump administration during our Overcoming Obesity 2018 conference in Washington, DC, September 26–30, 2018) and others are collaborative, with our partners in the Obesity Care Advocacy Network (OCAN). OCAN recently procured 158 co-sponsors on the House of Representatives bill and 10 on the Senate bill for the Treat and Reduce Obesity Act (TROA) of 2017. In July, members of the OMA board met with the United States Government Accountability Office (GAO) to discuss coverage of anti-obesity medications (AOMs) for patients with overweight and obesity under The Bipartisan Budget Act of 2018. During this meeting, compelling data was presented to support medical weight loss, and I strongly believe this research will help to achieve AOM coverage—a necessity for sustained weight loss. The OMA also collaborated under OCAN to respond to the Senate Finance Committee Chronic Care Working Group (SFC CCWG) to support the fact that as a disease, the treatment of obesity deserves reimbursement analogous to other chronic diseases.

The OMA has also been keenly aware of the outdated state laws regarding the prescription of AOMs, particularly older drugs, which put some providers who are practicing standard-of-care obesity medicine in jeopardy. To that end, OMA Vice President Dr. Ethan Lazarus formed an obesity caucus within the American Medical Association (AMA) and introduced resolution 201, which passed. Resolution 201 allows the AMA to work with state medical societies to help remove outdated restrictions at the state and federal levels.

As OMA President, I strongly believe we need to increase awareness of obesity medicine as a cost-effective solution to be embedded in the treatment of all obesity-related chronic diseases. To support this initiative, we participate in the National Obesity Care week (October 7–13, 2018), a joint effort with several organizations to introduce obesity care to the general public. The OMA is interested in expanding the nonsurgical treatment of obesity beyond our borders. For this reason, we are involved in several international partnerships, including International Classification of Diseases 11th Revision (ICD-11) updates to list obesity as a disease rather than a condition, United Nations (UN) and World Health Organization (WHO) international definition of obesity, global online obesity education as a joint initiative with and the World Obesity Federation (WOF), and Global Obesity Day to be celebrated in every country, which is a joint initiative with the Obesity Action Coalition (OAC), Canadian Obesity Network (CON), European Association for the Study of Obesity (EASO), The Obesity Society (TOS), World Obesity Federation (WOF), OMA, and others.

How have educational offerings in obesity medicine grown in recent years?

Dr. Scinta: Our educational offerings are exploding right now, both in terms of content and reach. When we rebranded from the American Society of Bariatric Physicians (ASBP) to OMA in 2015, we morphed into a robust educational provider and expanded our provider base to include nurse practioners (NPs) and physician assistants (PAs) along with physicians. We now have a NP/PA Obesity Management Certificate offering and are working collaboratively on the Obesity Medicine Fellowship Program. We are also working on training programs for physicians who are interested in just dipping their toes in obesity medicine, and are developing programs to help them address childhood and adult obesity in their primary care practices. Our adult and pediatric algorithms have recently been updated and are available in e-book formats now, taking advantage of technology to improve delivery of content. With the help of our new, dynamic Executive Director, Claudia Randall, we are working on virtual conferences, education pathways for all learner levels, and making our conferences and education more engaging and interactive in the classroom.

We are also excited to help introduce obesity medicine into the medical education curriculum in universities through the collaborative organization of Obesity Medical Education Collaborative (OMEC). With TOS, OMA, and the American Society for Metabolic and Bariatric Surgery (ASMBS), core competencies have been developed for medical students and physicians in training, with the hope of expanding this into more professional and comprehensive programs.

What resources does the OMA offer for clinicians?

Dr. Scinta: Current offerings from the OMA include the following:

1. Association conferences. OMA holds two annual one-week conferences (Spring and Fall) in different parts of the country that include a board certification review course, innovative didactic and dynamic education sessions, and networking opportunities.
2. Fundamentals of Obesity Treatment Courses. The Fundamentals of Obesity Treatment Course is a one-day course offering introductory education about the evidence-based approaches for evaluating, diagnosing, and treating obesity in a clinical setting. These courses, offered five times annually, are held in major cities across the country and give physicians a nice introduction to obesity medicine to see if they want to take it further and become board certified.
3. Obesity Medicine Academy. The Obesity Medicine Academy is an online, on-demand learning academy with business and clinical topics, expanding into learning pathways for different learner levels.
4. Webinars. A webinar learning series that is expanding to include podcasts as well.
5. Practical obesity medicine resources. We offer clinician resources, such as infographics, checklists, and other tools.
6. A career center. Browse open positions and post obesity medicine job listings for free in the OMA career center.
7. A fellowship program
8. Listing in a “Find a Physician” promotional database for patients.
9. An Adult and Pediatrics Algorithm. Available in e-book and PowerPoint formats, our Obesity Algorithms outline treatment plans, fully referenced.
10. ABOM Board Certification Prep Course
11. Continuing education. A plethora of CME- and MOC-accredited educational options
12. Foundation-related research and education grants.
13. Multiple resources for clinicians. A series of online videos, textbooks, facts, and forms that are practical usage tools for the everyday practice
14. Networking. Multiple networking opportunities with peers on social media, private online groups, and in-person events
15. Committee and taskforce involvement options
16. Member newsletter with current industry information
17. A robust website. Visit www.obesitymedicine.com for other resources and news articles.

What is the current state of pharmacotherapy for treatment of obesity?

Dr. Scinta: We still have a massive under utilization of AOMs, with only 1 to 2 percent of patients who qualify for weight loss medications obtaining prescriptions. This is despite the fact that they have been shown to double and triple odds of meaningful weight loss from a disease perspective. In comparison, 86 percent of Americans with Type 2 diabetes are treated with pharmacotherapy. Between phentermine, combination drug naltrexone HCl and bupropion HCl (Contrave®, Orexigen Therapeutics, Inc., La Jolla, California), liraglutide (Saxenda®, Novo Nordisk Inc, Plainsboro, New Jersey), and lorcaserin HCl (Belviq®, Eisai, Woodcliff Lake, New Jersey), we have excellent coverage for the increased hunger that occurs with weight loss, and phentermine provides an additional benefit of a slight increase in metabolism that counters our adaptive decrease with weight loss. In addition, topiramate (Topamax®, Janssen Pharmaceuticals, Inc., Titusville, New Jersey) and lisdexamfetamine dimesylate (Vyvanse®, Shire US Inc., Lexington, Massachusetts) are helpful for patients with binge eating disorder (BED), covering the hedonic pathway. So the medications are there, why aren’t they being written?

In the past, coverage has been an issue, but there are huge indications that the tide is turning. As we discussed previously, the GAO is exploring AOM coverage for the Medicare population, and the SFC CCWG is carefully considering defining obesity as a disease warranting coverage. In addition, we have met with the 5.5-million member Federal Employee Prgram from Blue Cross Blue Shied (BCBS), and are working on setting up multi-center medical weight loss pilots across the country that include coverage of AOMs. I believe we will see a drastic change in prescriptions in the years ahead, which means more patients will reach and maintain their weight loss goals, which makes me thrilled!

Are there any new therapies or pathways to treatment in the pipeline?
Dr. Scinta: Let me approach this question through our four pillars, because fascinating things are happening in each area.

1. Medications and Medical Management. According to Pharma Intelligence, dated March 2, 2018, there are currently 128 obesity drugs in active development. With recent research on metabolic adaptation, it is clear that pharmacotherapy will play a role in the future treatment of obesity.
2. Nutrition. I think we will soon move past the guessing game of dietary intervention and the belief that one diet fits all. I used to think I could get everyone to their goal on very low calorie diet (VLCD), or low-carb diet, but after doing this now for 12 years, I have come to realize that genetics, and more specifically, epigenetics, play a role, and it is indeed individualized. We are starting to enter an age of personalized nutrition, with new genetic and epigenetic markers revealed on a regular basis. And we have come to find that many of the epigenetic marks are modifiable, clearing the way for unique, individualized treatment modalities. Recent advances in nutrigenetics, bioinformatics and genome-wide metagenomic studies are set to unleash a revolution in personalized nutrition, in which will be exciting to participate!
3. Behavioral modification. As a former electrical/computer engineer, I see technology playing a huge role in the future of behavioral modification. In the age of artificial intelligence, eating patterns will be studied, analyzed, and responded to with messaging, interception, and redirection. This might happen through a device, such as a belt that alerts you when it becomes snug, such as Welt, a wellness belt by an independent start-up out of Samsung Electronics, or smart glasses/lenses that see your food, count your calories, and tell you what to remove from your plate to be compliant (Google Glass, Foxconn Technology Group, New Taipei, Taiwan). Personally, I feel that human interaction will still play a role, but to a lesser degree than in the past.
4. Exericise. Wearables will continue to predominate, but we will be tracking more interesting parameters, such as metabolism through blood glucose monitoring and cellular function.

The organization now known as OMA has evolved over the years. Please describe significant changes and their impact on obesity medicine.
Dr. Scinta: OMA rebranded from ASBP to OMA in 2015. The rationale was that the general public confused our organization with ASMBS too often and thought bariatrics means surgery. Obesity is a disease, therefore it makes sense to have our names represent that disease. Obesity medicine physicians and specialists now have a wealth of science and practice-based data to help change that image.

The OMA is the largest organization of physicians, NPs, PAs, and other healthcare providers working every day to improve the lives of patients affected by obesity. OMA members are the clinical experts in obesity medicine. They use a comprehensive, scientific, and individualized approach when treating obesity, which helps patients achieve their health and weight goals.

What we do. OMA offers resources, education, and community to physicians and other healthcare providers in the field of obesity medicine.

Membership. OMA has memberships available for physicians, nurse practitioners, physician assistants, and other healthcare providers, as well as medical students, residents, fellows, and other clinicians-in-training. We equip our members with the best resources to help them deliver evidence-based obesity treatments, provide optimal patient care, and build a rewarding career in obesity medicine. We foster collaborative relationships and promote the sharing of information to enrich the learning experience.

Education. OMA offers unique, accredited educational opportunities on topics related to the clinical treatment of obesity and the practice of obesity medicine. Our education spans all levels, for those looking for ways to treat obesity more effectively in primary care to those practicing obesity medicine full time. Our clinical expertise extends across the continuum of care, from diagnosis to maintenance, and includes our four treatment pillars: nutrition, physical activity, behavior, and medication.

Advocacy. OMA supports national and state-level advocacy efforts to increase access to and coverage of obesity treatment services to patients affected by obesity. We belong to the Obesity Care Continuum and OCAN. We also hold a seat in the AMA House of Delegates and host an Obesity Caucus biannually at AMA meetings.

How do you see the relationship between the OMA and bariatric surgery groups? How about other disciplines?

Dr. Scinta: As discussed, we have several collaborative projects with multiple partners. We have always had a strong relationship with our surgical colleagues, but I think now, more than ever, obesity medicine specialists and bariatric surgeons need to team up. Having worked with several surgical programs, I believe that the patient makes the decision, and there will always be a need for both modalities. I had always hoped to see more collaboration in the pre-operative and post-operative/long-term care of patients with obesity, and I see that happening on a national scale now, which is exciting.

What are future directions for the organization?

Dr. Scinta: The OMA is actively working on becoming the primary choice for clinicians nationwide who seek education on how to treat patients with obesity in a clinical, nonsurgical model. Our vision includes a robust national presence with focus on high-quality healthcare provider education, standard setting guidelines and educational pathways (e.g., OMEC, COE) and active advocacy engagement in Washington D.C. as well as on a grass-roots level.

Upcoming OMA initiatives include the following:

1. OMEC—competencies in partnership with TOS and ASMBS
2. Centers of Excellence guidelines to raise practice standards
3. Pediatric Algorithm e-book reference
4. Several certificates for primary care and pediatricians MDs (AAP), PA/NP certificate (AANP, AAPA)
5. MyCME e-monographs for easy online education with board reach
6. Obesity Medicine Specialist Bootcamp two-day course for board-certified providers
7. Podcast-based education
8. Interactive online education with quiz integrations for higher learning retention
9. International online virtual conference
10. Learning path-based educational pathways for all learner levels, including clinicians in training

Tags: Obesity Medicine Association, OMA, Overcoming Obesity 2018

Category: Interviews, Past Articles